The healthcare field is a teamwork oriented working environment. Yet as simple as the process seems, there are highly significant tools that are geared towards achieving the common goal of positive patient care outcomes. In a multifaceted health care team, nurses assume the core role of maintaining clear communication of the patient needs to each member of the team while assessing the changing needs of clients as they remain as patient care facilitators, initiators & advocates.
While tasked with interpreting & relaying information, we as nurses must communicate clearly, particularly throughout periods of intense stress. Usually, the process occurs in circumstances of different cultural and social norms and psychological states yet the capacity to initiate effective communication is crucial to imparting the highest quality of care and the best outcomes attainable in each unique case.
When handling emergencies in communication with physicians and other health care personnel, apprehensiveness might get in the way to hinder communication.
ISBAR has been developed over time as a tool to aid effective communication while simplifying documentation. ISBAR is highly effective when reporting critical conditions over the phone to describe emergent clinical changes and receive solution oriented feedback.
Once utilized, the self-directed tool bridges gaps created by communication challenges such as; Poor communication skills, Hand over interruptions, the proverbial ‘broken telephone’ in multidisciplinary teams & the well-known mood/attitude that some individuals allow to affect their communication.
Research shows that health workers untrained in communication skills tend to encounter challenges disarticulating work from their personal life. They tend to shift problems from once side to the other.
Another significant role of ISBAR is the inclusive feedback avenue in that it allows the nurses to actively provide their input in the decision-making care of the client. This we know, makes gains against the `doctor said so´practice by encouraging critical thinking, participation in the decision-making process and promoting patient advocacy. The inclusivity is the opportunity to provide recommendation, ask questions, seek clarification & confirm information.
Other benefits of ISBAR are;
- Improves collaboration in the multidisciplinary team
- Promotes effective flow of information
- Reduces the risk of errors
- Ensures positive clinical outcomes
- Improves the quality of care
- Facilitates continuity of care & transitional care through clear transfer of communication.
- Prevents communication gaps
- Fosters a culture of patient safety
The ISBAR acronym is broken down as follows:
Identity: Who you are and here you are calling from.Patients’ demographic data and room number.
Situation: Current state of the patient (the problem).
Background: Day of admission & Diagnosis. Clear and brief relevant past medical history. Treatment to date.
Assessment: Modified early warning signs & current vital signs. Your clinical judgement.
Recommendation: Explain what you need. Be specific about the timeframe. Ask anything more that can be done.
Documentation: Ensure you record the conversation.
Tips for using ISBAR:
Prior to phoning the doctor;
- Review report & patients notes in the past 24 hours – Gives a picture of the patients and possible causes of the clinical changes. You collect information pertinent to the conversation such as management & medication changes.
- Always assess the patient
Here is an example:
Identity: Hello Dr. Doe, my name is Nurse Cate i am calling from the female medical ward. I am calling about patient Jane Doe, a 46 year old client in bed 44 room 60.
Situation: I am concerned that her Blood Pressure is low at 80/40 mmHg with a high Pulse of 154 bpm and temperature is unrecordable.
Background: The patient was admitted three days ago (or the date of admission) with Bacterial Meningitis. She has undergone pleural tap and is currently on the following medications: (List the relevant drugs)
Assessment: The early warning signs 10 minutes ago at 11:20 pm were BP: 100/50mmHg, P: 150bpm, T: Unrecordable, Resp;20bpm, SPO2; 89% on oxygen via nasal prongs at 4L/min. She is confused with a GCS of 10.
I put her on fluids: Normal saline running at 30 drops per minute and covered her with a thermal blanket
Recommendation: I think the patient is going into shock. I am not certain the type of shock but i would like for you to review her urgently. Would you give me the management plan meanwhile?
(The doctor will then give his recommendation).
Repeat the recommendation just to clarify and document the conversation.